Department of Medical Imaging, Jinling Clinical Hospital, Nanjing Medical University, 305 Zhongshan East Road, Xuanwu District, Nanjing, 210002, Jiangsu, China.
Department of Medical Imaging, Medical Imaging Center, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an, 223300, Jiangsu, China.
Cancer Imaging. 2020 Oct 16;20(1):73. doi: 10.1186/s40644-020-00355-6.
Previous studies have found abnormal structural and functional brain alterations in breast cancer survivors undergoing chemotherapy. However, the network-level brain changes following chemotherapy remain unknown. The purpose of this study was to investigate the dynamic changes of large-scale within- and between-network functional connectivity in chemotherapy-treated breast cancer patients.
Seventeen breast cancer patients were evaluated with resting state functional MRI (rs-fMRI), neuropsychological tests and blood examination before postoperative chemotherapy (t0), one week after completing chemotherapy (t1) and six months after completing chemotherapy (t2). Nineteen age- and education level-matched healthy controls (HC) were also recruited. Independent components analysis (ICA) was performed to assess network component using rs-fMRI data. The functional network changes were then correlated with cognitive assessment scores and blood biochemical indexes.
One-way repeated measures ANOVA revealed significantly changed within-network functional connectivity in the anterior and posterior default mode network (ADMN and PDMN), left and right frontoparietal network (LFPN and RFPN), visual network and self-referential network. Post-hoc test showed that decreased within-network functional connectivity in ADMN, PDMN, LFPN, RFPN, SRN and central network one week after chemotherapy and increased six months after chemotherapy (all P < 0.05). As for the between-network functional connectivity, the PDMN- sensorimotor network connectivity showed the same tendency. Most of these within- and between-network functional connectivity changes were negatively associated with blood biochemical indexes and cognitive assessment scores (all P < 0.05).
These results indicated that chemotherapy may induce widespread abnormalities in resting state networks, which may serve as a potential biomarker of chemotherapy related cognitive impairment, providing insights for further functional recovery treatment.
先前的研究发现，接受化疗的乳腺癌幸存者的大脑结构和功能存在异常改变。然而，化疗后大脑的网络级别的变化仍不清楚。本研究旨在探讨化疗后乳腺癌患者的全脑功能连接网络内和网络间的动态变化。
本研究共纳入 17 名乳腺癌患者，在术后化疗前（t0）、化疗结束后一周（t1）和化疗结束后六个月（t2）时进行静息态功能磁共振成像（rs-fMRI）、神经心理学测试和血液检查。还招募了 19 名年龄和教育程度匹配的健康对照组（HC）。采用 rs-fMRI 数据进行独立成分分析（ICA）来评估网络成分。然后将功能网络变化与认知评估评分和血液生化指标相关联。
单因素重复测量方差分析显示，默认模式网络的前后部（ADMN 和 PDMN）、左右额顶叶网络（LFPN 和 RFPN）、视觉网络和自我参照网络的网络内功能连接发生了显著变化。事后检验显示，ADMN、PDMN、LFPN、RFPN、SRN 和中央网络的网络内功能连接在化疗后一周内降低，而在化疗后六个月内增加（均 P<0.05）。对于网络间功能连接，PDMN-感觉运动网络的连接也表现出相同的趋势。这些网络内和网络间功能连接的大部分变化与血液生化指标和认知评估评分呈负相关（均 P<0.05）。
这些结果表明，化疗可能会导致静息状态网络中广泛出现异常，这可能成为化疗相关认知障碍的潜在生物标志物，为进一步的功能恢复治疗提供了思路。
